Consent to the Collection, Use and Disclosure of Personal Information (Freedom of Information and Protection of Privacy Act).

I consent to the collection, use and disclosure of my personal information as provided in the above application form, including my name, photograph and academic achievement information, for the purpose of the Grant Program showcasing my academic successes on the Early Childhood Education Upgrade Program’s Website.

I agree that the North Bay Regional Health Centre may, subject to applicable privacy legislation, freely use, publish, copyright and otherwise deal with any reproduction indicated above for the purpose(s) of: Public Relations – to be used in the ECE Grant Program publications, videos, advertising, promotions, social media sites, fundraising, public awareness, presentations, web site or other programs/projects.

I further agree that these photographs and/or video(s) may be showcased on the ECE Upgrade Program Website - Wall Of Graduates. I understand that this is a publically available website and that North Bay Regional Health Centre cannot be held responsible if my personal information is used, extracted from, or copied from the website by individuals, organizations, and/or news media.

I have had the opportunity to ask questions about this consent and all of my questions have been answered to my satisfaction.

I understand that I may revoke this consent at any time, and that my revocation will not be retroactive.

Finally, I confirm that that the person in the photograph uploaded is of myself and does not include any other non-consenting individuals.